Does Virtual Therapy Actually Work?

This is one of the questions I get most often. And the short answer, backed by a now-substantial research base, is: yes. For most people and most presentations, virtual therapy produces outcomes equivalent to in-person therapy.

Here is the longer answer — including where the evidence is strongest, where there are genuine considerations, and what makes virtual therapy actually work.

What the Research Shows

The research base on telehealth therapy has grown enormously, particularly following the COVID-19 pandemic, which accelerated a global natural experiment in the delivery of mental health care via video. Meta-analyses published in the years since have consistently found:

• Virtual CBT produces equivalent outcomes to in-person CBT for depression and anxiety disorders
• Telehealth EMDR for PTSD shows equivalent effectiveness to in-person EMDR in randomized controlled trials
• Therapeutic alliance — the quality of the relationship between therapist and client — can be established and maintained effectively via video
• Client satisfaction with telehealth therapy is generally high, often higher than anticipated pre-treatment
• Dropout rates and treatment completion are comparable between telehealth and in-person delivery

This is not a consolation prize — the finding that virtual therapy is “almost as good.” For the large majority of presentations and the large majority of clients, the evidence says it is as good.

Access Advantages That Matter

Beyond equivalence, virtual therapy offers genuine advantages that matter for outcomes:

Geographic access. Many people — in rural areas, in communities underserved by mental health providers, or simply in a city where the commute to a therapist is 45 minutes each way — can access specialized care they otherwise couldn't. A trauma specialist in Scarborough can work with someone in Timmins.

Reduced barriers. Transportation, mobility, childcare, work schedules, and stigma (not wanting to be seen entering a therapist's office) all reduce access to in-person care. Virtual therapy removes or reduces many of these barriers.

Comfort and safety. For some clients — particularly those with agoraphobia, social anxiety, trauma responses triggered by leaving home, or trauma histories that make being in enclosed spaces with an unfamiliar adult activating — beginning therapy from home can provide a safety buffer that enables engagement that might not otherwise be possible.

Consistency. Travel time, weather, and schedule pressures are common reasons people cancel or discontinue in-person therapy. Virtual therapy reduces these friction points, which supports the regularity and consistency that are important for therapeutic progress.

Genuine Considerations

There are presentations and situations where in-person therapy has advantages or where virtual therapy requires more careful consideration:

Severe crisis. Someone in acute suicidal crisis is better served by in-person care where safety planning and, if necessary, intervention are more practically available.

Severe dissociation or derealization. Working with severe dissociative states requires the therapist to be able to closely observe the client's physical state and to provide grounding that is easier in person.

Limited privacy at home. If you don't have a genuinely private space to speak freely — if a partner, parent, or roommate may overhear — the therapeutic space is compromised. This is worth problem-solving before beginning.

Personal preference. Some people simply connect better in person, for reasons that may not be fully articulable. If after a genuine trial of virtual therapy you consistently feel that the medium is getting in the way of the work, in-person is worth pursuing if accessible.

What Makes Virtual Therapy Work

The same things that make any therapy work: a good therapeutic alliance, a skilled and well-matched therapist, regular and consistent attendance, and your willingness to engage with the process. The medium is secondary to these factors.

One practical suggestion: treat your virtual sessions as you would in-person appointments. Set up a private, comfortable space. Put your phone away. Close other tabs. Be there.

Andrew Garnet MSW, RSW

Registered Social Worker with 18 years of experience in Scarborough, Ontario. Andrew specializes in trauma therapy, EMDR, men's mental health, and support for first responders and veterans. Full bio →